“Natural” childbirth defies a single definition

Jamaica Plain resident Liz Myers is currently in the second trimester of her first pregnancy. Her definition of a natural birth is an intervention-free birth at home, which she is preparing for reading books such as "Bliss Born," which promote intervention-free births.

By Cassidy Swanson

4/28/2014

Before hospital births, episiotomies, epidurals, forceps, Pitocin and much more, there was just…birth. The location and rituals varied, but all over the world, women gave birth about the same way: un-medicated (though natural remedies may have been used), with a midwife or an equivalent, and almost always exclusively in the company of other women.

Before the concept of a “high-risk pregnancy” was recognized, maternal and especially fetal death were common, as there was no way of knowing if something was going wrong internally and medical interventions were primitive at best. But the majority of women delivering the “old-fashioned way” lived. For most women, pregnancy and birth are natural, normal, healthy processes. Today, this idea is embraced by advocates of more natural birth, in midwifery, the medical community, and by expectant mothers.

However, there is no definition of what “natural birth” is; it means different things to different people. For the most part, people agree that natural means vaginal delivery, no drugs and no surgery. But there are those who think a woman can have a hospital birth and have it still be considered natural, and others who believe a true natural birth takes place at home, with a midwife. There are other scenarios in between that people consider natural, too.

Birth itself is “natural”

Michelle Malette is a registered nurse certified in patient obstetrics and maternal newborn nursing, and a labor and delivery nurse at the Elliot Hospital in Manchester, N.H., about 50 miles northwest of Boston. Malette works with women through every stage of pregnancy and birth, and over time has learned what “natural” means to each patient.

“I talk to people a little bit more about what they mean by ‘natural’ birth, and really what it is, is they feel like it’s a non-medicated, non-interventional birth, with a big piece of it with the stress on the pain relief,” Malette said. “To a lot of women, natural birth means, ‘I don’t take any drugs, I deliver my baby vaginally, I go through the pain and tribulation of labor, I experience it with all my capacities, without any outside chemicals or anything entering my body.’”

Malette’s own opinion of what natural means is a bit different: “I feel like a woman can have a natural birth with an epidural, because it’s the process of birthing and it’s the process of having the baby that’s natural,” she said.

“Really, all birth is natural,” she said. Golen added that when a patient does ask for a natural birth, she asks her to be specific about what that means to her.

“The two most common reasons people use that terminology and what they mean by it is to mean a vaginal delivery, or…mean a delivery that doesn’t have any medication associated with it, or doesn’t have any pain relief associated with it,” Golen said. “But for me, I don’t use that term, because it doesn’t mean something specific to me.”

First-time mom planning a natural delivery

Jamaica Plain resident Liz Myers is currently in the second trimester of her first pregnancy. Her definition of a natural birth is an intervention-free birth at home, which she is preparing for reading books such as “Bliss Born,” which promote intervention-free births.

In Boston, women’s natural birth experiences vary. Liz Myers, 32, of Jamaica Plain, is currently in the second trimester of her first pregnancy and is planning a natural birth at home with a midwife. She said the choice was an “organic” one for her considering her lifestyle.

“As I’ve kind of built my own adult life after college, I’ve gotten more interested in sustainability and wanting to that way,” Myers said. “And I’m a coach and a leadership consultant, so I’m in the whole business of consciousness-raising in my clients — like, that’s what I do. When you combine all those things, it just makes sense that I would do a natural birth.”

The choice to deliver at home, for Myers, felt, well… natural.

“When the time came for me to make that decision, I thought about ‘Where am I going to be most comfortable?’ It was less about ‘Do I want a medicalized birth or do I want a naturalized birth?’ but, ‘Where do I want to give birth where it’s going to be a positive experience and be comfortable?’”

Home birth was painful, but worth it

Lawney’s birth was attended by Audra Karp, a midwife from Roslindale, pictured here with another patient. In addition to being free of medical or surgical interventions, home births often involve family members, like husbands and children. Courtesy of Audra Karp. Photo used with permission.

Molly Lawney, 27, of Jamaica Plain, had a birth experience that was about as natural as possible: at home, free of any medical interventions, and attended by a certified professional midwife and an apprentice midwife. A public health master’s student at Boston University, Lawney’s decision to not deliver in a hospital was based in her existing knowledge of hospital statistics of medical interventions such as C-sections, induction and epidural administration, and of the safety of delivering at home for a healthy woman with a low-risk pregnancy like herself.

“I’m just terrified of hospitals,” Lawney admitted. She considered the Cambridge Birth Center at Cambridge Hospital but decided against it after learning their transfer rate – the number of women who are transferred to the hospital after the birth center staff deems a labor and delivery to be high-risk – saying, “I was not really comfortable with almost a 50 percent chance of ending up in the hospital.”

While she admits that delivering her daughter the old-fashioned way was very painful, Lawney said she wouldn’t have had it any other way.

“Even though it was not an enjoyable experience by any means – probably the hardest thing I’ve ever done – I do think I did it the way I wanted, and I would definitely do it that way again,” she said.

A modified approach

Laura Stubbart, 34, of Roslindale, took a more modern approach to her natural birth. While she did opt out of medical interventions, she delivered her daughter at Newton-Wellesley Hospital, and an obstetrician attended her birth.

While she was generally pleased with the care she received from her obstetrician, Stubbart said she would probably choose a midwife for her care if she becomes pregnant again.

“Just the general attitude of the doctors [was] almost alarmist about little things that I knew weren’t really a big deal,” she said. “[The doctor who attended my birth] wasn’t even somebody from the regular OB practice who was on call; it was somebody from a sister practice, somebody I’d never met, who didn’t know me at all … My water hadn’t broken yet, and the first thing out of the obstetrician’s mouth was, ‘So, when we break your water…’ I was like, ‘Um, no. We’re not doing that.’”

And sometimes, interventions are necessary

Bridget Colvin, 35, of Roxbury, had different experiences with all three of her children, one intervention-free and at home, and two with interventions.

“I was in active labor for a really long time,” she said of her first birth, which was ultimately induced with the drug Pitocin. “I ended up getting an epidural after, like, 48 hours of labor, and then he was born really quickly after that.”

While the epidural was helpful in starting the delivery process, Colvin said she and her partner didn’t think a hospital setting was the best place for a long labor like she had.

“We thought we’d try a home birth with our second,” she said. “That was a long labor too – that was 26 hours – but he was born with no interventions, easy.”

They planned for another natural home delivery with their third, but because the baby was in a difficult position and had a short umbilical cord, things didn’t go as planned.

“After about 48 hours or so in labor with him, we went over to [Brigham and Women’s Hospital],” she said. “I had an epidural, and he was born shortly after that.”

Colvin is a natural birth educator and promotes intervention-free birth whenever possible. However, as a woman who has benefited from epidurals, she believes they do have their place.

“Maybe there could have been other that things we had done differently to not get to that position, but I don’t regret the epidural in both cases,” she said. “It was what we were ready to do. It was a good choice.”

So the choice of a “natural” birth is just the start of sorting through available options that include, but are not limited to:

The act of giving birth, period

Vaginal delivery without medicinal/chemical pain relief

Vaginal delivery with epidural analgesia

Home delivery

Hospital delivery

Delivering with a midwife

Delivering with a doctor

Christina Van Becelaere, 27, of Roslindale, delivered her son, now 5 months, with an ob-gyn at Tufts Medical Center, without drugs or surgery. She does not believe the concept of a “natural” delivery needs to fit into any one box.

“Even though I do believe in what I’ve done strongly, I do believe that every woman deserves the labor that she wants,” she said. “I don’t think there should be any judgment.”

Cassidy Swanson is an experienced reporter and holds a master's degree in print and multimedia journalism from Emerson College. She has held staff writer positions at two newspapers and is currently a production assistant at National Public Radio's "Here & Now." A native New Englander who has lived in Rhode Island, New Hampshire and Massachusetts, Cassidy loves this area of the country and would like to one day write for a regional publication. Cassidy is passionate about telling stories through features, both in the print and public radio format, especially ones that shed light on the extraordinary contributions of ordinary people.